Hemodynamics, fluids & transfusion
Development and validation of the Hypotensive Exposure Duration Index for mortality risk prediction in critically ill patients
Authors' conclusion
HEDI effectively quantifies cumulative hypotensive burden in critically ill patients, demonstrating significant predictive ability for ICU mortality validated across diverse populations.
Study context
- Population
- ICU admissions with continuous invasive arterial monitoring, Salzburg Intensive Care Database; external validation in eICU database
- Participants
- 11,059 ICU admissions
- Exposure
- Hypotensive Exposure Duration Index (HEDI) in non-survivors vs survivors
- Outcome
- ICU mortality prediction by HEDI (cumulative hypotensive burden across multiple MAP thresholds)
Methodological detailsprognostic model development and validation, machine learning, external validation
- Prognostic model development and validation
- Machine learning
- External validation
Main finding
As reported in the abstract
HEDI
Non-survivors
0.47
interval −0.20–1.43
Survivors
−0.15
interval −0.41–0.27
P < 0.001
Observational data: associations, not effects.
Further findings
Predictive capability of HEDI (AUC) over time post-admission · 24 h to 72 h
- AUC at 24 h
- 0.624
- AUC at 72 h
- 0.700
Extra Trees classifier performance
- Test AUC
- 0.843
- HEDI among top predictive features
Internal cross-validation and external validation
- Model robustness confirmed across populations, incl. patients with and without vasopressor use
Original publication
Development and validation of the Hypotensive Exposure Duration Index for mortality risk prediction in critically ill patients. J Intensive Care. Published 3 December 2025. doi:10.
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